Provider Demographics
NPI:1659743136
Name:SHANKS, CRAIG O (LPC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:O
Last Name:SHANKS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 E BAYFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-4408
Mailing Address - Country:US
Mailing Address - Phone:715-779-3707
Mailing Address - Fax:715-799-3362
Practice Address - Street 1:36745 AIKEN RD
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:WI
Practice Address - Zip Code:54814-4579
Practice Address - Country:US
Practice Address - Phone:715-779-3707
Practice Address - Fax:715-779-3362
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5425-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health